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A Guide to a Healthy Pregnancy

Looking after yourself during pregnancy will not only be good for you, it will help to give your baby a healthy start

  • Stay physically active
  • Eat a healthy diet
  • Gain weight wisely
  • Avoid risky substances
  • Prepare for the future/ combat challenges

Eating Well

A balanced healthy diet before and during pregnancy is vital. The growing fetus puts extra demands on the body. Fetal growth depends on the health and nutritional status of the mother before conception and during pregnancy.

  • Eating healthily can make a difference in how you feel and cope during and after pregnancy
  • A healthy diet helps your baby grow and develop
  • Eat enough but not too much
  • Take a pregnancy vitamin tablet

General dietary guidance for pregnant women includes:

  • Eat a wide variety of foods
  • Eat regular meals and snacks
  • Make sensible food choices based on healthy eating principles (Food Pyramid Model)
  • Encourage plenty of wholegrain cereals, bread, rice, pasta and potatoes
  • Have at least 4 portions of fruit and vegetables daily
  • Increase to 5 servings from milk and dairy product shelf (can use low fat varieties if concerned about excess weight gain)
  • Increase to 3 servings / day from meat / fish / beans / eggs shelf
  • Remember that energy requirements are not increased in the 1st trimester and that requirements are only increased by 200kcal / day in 2nd and 3rd trimester (e.g. an extra slice of bread /spread and piece of fruit). Do not need to ‘eat for two’ so while eating, take care that consumption of fat rich and sugar rich food choices are not so excessive that they displace more nutrient dense foods from diet, or lead to excessive weight gain.

Weight gain

It is a good idea to start pregnancy at a healthy weight. The best advice for women during pregnancy is to eat according to appetite and monitor weight gain. Studies have shown that weight gained at an excessive rate by women with a normal pre-pregnancy BMI does not enhance fetal growth but does contribute to postpartum maternal obesity.

Women with a pre-pregnancy BMI within the normal range should aim for a pregnancy weight gain of between 7kg and 12kg. Women with a pre-pregnancy BMI below 19.8 should aim for greater weight gain.
For adolescents, a greater and earlier increase in energy intake may be required.

Note:
If pregnant and following a specific diet e.g. diabetic or strict vegetarian, can ask to be referred to hospital / community dietitian, to receive individual advice.

Specific Nutriants

Iron
Iron is important to help make the extra blood needed by both mum and baby. No increment required unless maternal stores depleted at start of pregnancy. There is increased need but this is compensated for by increased absorption of iron and decreased losses (menstruation).

Iron supplementation is common in pregnant women. While it is not necessary to take supplements if stores are adequate – it is important to have haemoglobin levels measured regularly. Good dietary sources of iron are lean red meat, poultry, fish and eggs. Plant foods that are rich in iron include fortified breakfast cereals, green vegetables and dried fruit. Including a vitamin C source e.g. orange juice with iron containing food will help absorption from non-meat sources.

Doctor or midwife will advise on taking iron supplements. As side effects can occur, it may be more beneficial to start supplements in 2nd / 3rd trimester. Side effects include constipation, nausea and diarrhoea.

Folate
Folic acid is a vitamin that is vital for the development of the unborn baby’s brain and spine. There are good dietary sources of folic acid, but in order to meet the needs of the baby it is recommended that supplements be taken before becoming pregnant and during early pregnancy (until 12 weeks pregnant). This can help to protect from neural tube defects including spina bifida.

If mum is already pregnant and has not been taking supplements, then advise taking them as soon as possible. Folic acid supplements can be bought over the counter from pharmacy or can be obtained free of charge on prescription from doctor for those with medical cards. Continue with good dietary sources of folic acid (e.g. green vegetables, oranges) and foods that have been fortified with folic acid (e.g. breakfast cereals, some breads /milk) throughout pregnancy.

Calcium
During pregnancy, calcium is provided to baby for bone and tooth development. Extra calcium is required to replace this loss.
It is recommended to include at least 5 servings of calcium rich foods daily (refer to Food pyramid). Milk, cheese and yogurt are the best sources of calcium – other sources include tinned salmon / sardines and dark green leafy vegetables e.g. broccoli. Some types of breakfast cereals, bread, orange juice and most Irish flour are fortified with extra calcium.

Low fat varieties of dairy products contain similar amounts of calcium as full fat varieties.

Vitamin D
Vitamin D helps to absorb calcium from foods. Most of our Vitamin D is obtained from sunlight. Dietary sources include oily fish (salmon, herring, trout, sardines), milk, margarine, cheese and eggs. Some milks and breakfast cereals are fortified with extra vitamin D.

Smoking and Pregnancy

  • The chemicals you inhale in cigarettes can reduce the blood flow, nutrients and oxygen to your baby.
  • Your baby will be born smaller and weaker than normal
  • Increased risk of Stillbirth
  • Increased risk of Cot-death/Sudden Infant death Syndrome (SIDS)Passive Smoking

Increased risk to the baby of:

 Respiratory illness
 Impaired intellectual development
 Birth defects
 Low birth weight e.g NICU

If you wish to seek assistance in stopping smoking, the Midwife or Doctor will give you the number for your local Smoking Cessation Officer. A direct referral can also be made at your request.

Pregnancy and Alcohol

Alcohol entering the mother’s blood stream passes into the baby’s blood stream. It is recommended that no alcohol be consumed during Preganancy.

 Alcohol use in pregnancy at any stage can seriously affect the development of your baby
 Some babies born to mother’s who drink have been found to have physical and mental abnormalities – Fetal Alcohol Syndrome
 Children who were exposed to alcohol in pregnancy often show poor attention and hyper-activity.

Substance Use During Pregnancy

Any drugs/substances you use enters your bloodstream, and passes to your baby through the placenta.
 Substance refers to both legal and illegal drugs and over the counter medications
 Legal i.e. tobacco, alcohol
 Illegal i.e. cannabis, benzodiazepines, cocaine, heroin

It is never too late to stop, please discuss with your midwife or doctor.

Cannabis and Pregnancy
Possible Effects on Mother

 Anxiety, paranoid, memory loss and concentration problems, depression
Possible Effects on Your Baby

 Your baby may be born weaker and smaller than normal
 The oxygen supply to your baby will be decreased
 Increased risk of cot-death
 Increased risk of asthma

Dietary Management of Common Problems During
Pregnancy

Nausea and vomiting (Morning sickness)
• Eat dry cereals or crackers before getting out of bed. Get out of bed slowly
• Eat small, frequent meals. Small carbohydrate-rich snacks at frequent intervals can
• provide relief
• Avoid any foods that cause nausea
• Drink liquids between, rather than with, meals to avoid abdominal distension that can
• trigger vomiting
• Avoid large / greasy / spicy meals
• Suck something sour e.g. lemon
• Slowly sip a fizzy drink when nauseated
• Get plenty of fresh air. Keep rooms well ventilated and odour free.
• Avoid the smell of food cooking or the cooking environment
• Try food and drinks containing ginger – can help
• If symptoms are severe and persist, then contact your doctor or midwife.
Heartburn
• Eat small, frequent meals
• Avoid spicy, fatty, fizzy or acidic foods
• Eat slowly and chew all food well
• Avoid lying down after eating
• Milk and yogurt may help to relieve symptoms
• If heartburn persists and is excessive, ask your doctor or midwife for further advice.
Constipation
• Often occurs at later stage of pregnancy
• Eat more fibre rich foods e.g. wholegrain cereals, wholemeal bread, fruit and vegetables
• Drink plenty of fluids – include at least 8-10 glasses of water each day when following a
• high fibre diet.
• Regular exercise can be beneficial.

Foods to Avoid

Liver and liver pates / Cod liver oil
Large quantities should be avoided as contain high levels of Vitamin A, which can harm baby. It is important that pregnant women do not take un-prescribed or non-pregnancy vitamin supplements, as these may be high in vitamin A.

Caffeine
Found in coffee, tea and cola type drinks. Limit to 2 cups daily. Can reduce iron absorption and affect body weight of baby.

Alcohol
Drinking alcohol during pregnancy can damage the unborn child, and in severe cases can result in Fetal Alcohol Syndrome. Pregnant women should avoid alcohol during pregnancy.

Tuna fish
Food Standards Agency in UK recommends that pregnant and breastfeeding women limit their consumption of tuna to no more than two medium sized cans of tuna / one fresh tuna steak per week (due to mercury levels in fish).

Peanuts
The incidence of peanut allergy is increasing and the reaction can be severe. The risk of allergy is increased if parents suffer from allergic disease e.g. asthma, hay fever.
If from this background, then avoidance of peanuts while pregnant and breastfeeding may help to reduce risk of infant developing allergy.
Note: Many manufactured products can contain peanut traces.

Listeriosis
Causes by bacterium listeria monocytogenes Infection can lead to stillbirth, or delivery of an acutely ill infant.
Avoid foods that contain significant amounts of organism:
• soft ripened cheeses, e.g. Brie, Camembert, cheese made from goats or sheep milk,
blue veined cheese.
• unpasteurised milk or any products made from this
• Pre-cooked or ready-prepared cold foods which will not be reheated e.g. purchased
salads, pates, quiches, cold meat pies.

Salmonellosis
Severe infection can trigger miscarriage or premature labour
Avoid:
• raw eggs or products containing raw eggs e.g. cold soufflés, mayonnaise
• raw or undercooked meat, poultry, fish and shellfish. Meat and fish that are ‘smoked’ or
‘cured’ are unsuitable unless fully cooked. Steaks should be ‘well-done’.

Toxoplasmosis
Commonly found in raw meat, unpasteurised milk and cat faeces
Advise avoidance of same, also
• Wear gloves when gardening
• Wear gloves when handling cat litter trays
• Ensure good hygiene if cat has access to kitchen
• Always wash fruit and vegetables.
• Take care when eating out, especially if abroad, to always avoid raw vegetables and
salad and un-peeled fruit.

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